Choi, Yoon-Jung

Kim, Ung

Kim, Young-Jo

Lee, Jin-Sung

Lee, Sang-Hee

Park, Jong-Seon

Shin, Dong-Gu

Son, Jang-Won

Elsevier - Publisher Connector 

Methods: We examined all patients In the NHLBI Dynamic Registry presenting with
ACAD and SA to understand difference in clinical characteristics and 1-year adverse
events.
Results: Of all patients in the NHLBI Dynamic Registry, 2174 underwent PCI for SA,
and 742 for ACAD. Patients receiving revascularization for ACAD compared to SA were
more likely to have a history of congestive heart failure (14% vs 9%, p0.0001) and HTN
(75% vs 71%, p0.05). In addition, Patients with ACAD had an increased prevalence of
non-cardiac comorbidites compared to SA patients (43% vs 31%, p0.0001) which
included a significant increase in renal disease (10% vs 6% p0.001), peripheral vascular
disease (10% vs 7%, p0.05), pulmonary disease (10% vs 6%, p0.01), and cancer (15%
vs 11%, p0.01). The prevalence of hyperlipidemia (72% vs 75%) and diabetes (33% vs
30%) were similar in both groups. There were no differences between the extent of
coronary artery disease or prior myocardial infarction in patient revascularized for ACAD
and SA. The combined adjusted 1-year mortality and reinfaction incidence (hazard ratio
0.95; 95% CI; 0.69-1.3) were similar between ACAD and SA patients.
Conclusions: Our analysis shows that patients with ACAD have similar 1-year outcomes
to SA patients after undergoing PCI while having increased co-morbid conditions. Given
these findings, further study is needed on the outcomes of patients with ACAD so that
they can be more appropriately represented in the AUC guidelines.
TCT-663
A United Kingdom Perspective on the Appropriateness of Percutaneous
Coronary Intervention in Stable Angina
Benjamin Wrigley1, Nikesh Malik1, Amerjeet Banning1, Raj Rajendra1,
Gail Richardson1, Anthony Gershlick1
1University Hospitals of Leicester, Leicester, United Kingdom
Background: The utilization of the ’appropriate use criteria’ (AUC) has been contro-
versial and suggested inappropriate and uncertain PCIs may not be uncommon. The issues
raised are unlikely to be confined to the US. We therefore applied the AUC to patients
with stable angina undergoing PCI at our tertiary centre in order to gain a UK perspective.
Methods: We performed a restospective analysis of 200 consecutive patients with known
stable angina referred from the chest pain clinic for PCI. The appropriateness of PCI was
adjudicated using the published AUC and patients were grouped into those apparently
undergoing appropriate, inappropriate or uncertain PCI.We determined the proportion of
patients in the uncertain group who had either significant symptoms, intermediate risk or
optimal medical therapy (OMT) in order to determine those in whom PCI is known to be
beneficial and those where the evidence is less clear.
Results: One hundred and twenty nine (64.5%) of PCIs were classified as appropriate,
while 64 (32%) could be classified as uncertain indications and 7 (3.5%) were deemed
inappropriate (Table 1). Inappropriate procedures were more common in patients with
CCS I/II, those with low risk stress testing and in those not receiving OMT. Of the
uncertain PCIs, 55 (85.9%) patients had either CCS III/IV, intermediate risk stress tests or
were on OMT, with 9 (14.1%) having either CCS I/II, low risk stress tests or no OMT.
Variable
Appropriate
(n129)(%)
Uncertain
(n64)
(%)
Inappropriate
(n7) (%) p value
Angina 0.036
none 0 0 0
CCS I 13 (10.1) 11 (17.2) 0
CCS II 73 (56.6) 44 (68.8) 7 (100)
CCS III 36 (27.9) 8 (12.5) 0
CCS IV 7 (5.4) 1 (1.6) 0
Risk on noninvasive
testing
0.001
low 11 (8.5) 10 (15.6) 7 (100)
intermediate 65 (50.5) 40 (62.5) 0
high 39 (30.2) 0 0
not performed 14 (10.9) 14 (21.9) 0
Antianginals 0.027
optimal (2
drugs)
83 (64.3) 13 (20.3) 0
minimal/none
(2 drugs)
46 (35.7) 51 (79.7) 7 (100)
Coronary stenoses 0.027
1 67 (51.9) 40 (62.5) 5 (71.4)
2 37 (28.7) 22 (34.4) 2 (28.6)
3 25 (19.4) 2 (3.1) 0
Proximal LAD
stenosis
51 (39.5) 18 (28.1) 0 0.043
CCS III/IV or
intermediate risk
or OMT
– 55 (85.9) – –
CCS I/II or low risk
or no OMT
– 9 (14.1) – –
Conclusions: The majority of PCI for stable angina was appropriate, with only 3.5% of
procedures deemed inappropriate. Almost one third fall within the uncertain category
creating a clinical challenge. We have shown that the majority have either significant
symptoms, an intermediate risk on stress testing or are on optimal medication. Conse-
quently, many are likely to warrant and benefit from PCI and care must be taken not to
deny them this treatment for the fear of ’inappropriate’ criticism.
TCT-664
Seven-year Clinical Outcomes of Sirolimus-Eluting Stent Versus Bare-Metal
Stent; A Matched Analysis From A Real World, Single Center Registry
Jin-Sung Lee1, Yoon-Jung Choi1, Ung Kim1, Jong-Seon Park1, Jang-Won Son2,
Sang-Hee Lee1, Dong-Gu Shin1, Young-Jo Kim1
1Yeungnam University Medical Center, Daegu, Korea, Republic of, 2Yonsei
University Medical Center, Seoul, Korea, Republic of
Background: The aim of this study is to compare clinical outcomes for seven years,
between sirolimus-eluting stent (SES) and BMS.
Methods: During the BMS and drug-eluting stent (DES) transition period (from April
2002 to April 2004), 434 consecutive patients with 482 lesions underwent percutaneous
coronary intervention, using BMS or SES. Using propensity score mathing, 186 patients
with BMS and 166 patients with DES were selected. Seven year clinical outcomes of
major adverse cardiac events (MACE), such as cardiac death, myocardial infarction (MI)
and ischemia-driven target vessel revascularization (TVR), and angiographic definite stent
thrombosis (ST) were compared.
Results: At the clinical follow up for 1 year, patients with DES showed significantly
lower MACE (9.1% in BMS vs. 3.0% in DES, p0.024) than those with BMS. This
reduction was mainly driven by a decrease in TVR (8.1% vs. 2.4%, p0.024), although
there was no significant difference in MI or death. However, cumulative MACE for 7
years was similar (24.7% in BMS vs. 17.4% in DES, p0.155). There was no significant
difference in MI (4.3% in BMS vs. 3.0% in DES, p0.571), TVR (15.6% in BMS vs.
15.7% in DES, p0.862), death (9.1% in BMS vs. 5.4% in DES, p0.218) and ST (1.1%
in BMS vs. 1.8% in DES, p0.533).
Conclusions: The TVR were gradually increased from 1 to 7 years in DES, on the
contrary to that of BMS. Although DES showed better clinial outcomes in the early period
after implantation, it didn’t show significant benefits in the long-term follow up, compared
with that of BMS.
TUESDAY, OCTOBER, 23, 8:00 AM–10:00 PMwww.jacc.tctabstracts2012.com
JACC Vol 60/17/Suppl B | October 22–26, 2012 | TCT Abstracts/POSTER/Bare Metal and Drug-Eluting Stents B193
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TCT-664 Seven-year Clinical Outcomes of Sirolimus-Eluting Stent Versus Bare-Metal Stent; A Matched Analysis From A Real World, Single Center Registry 

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TCT-664 Seven-year Clinical Outcomes of Sirolimus-Eluting Stent Versus Bare-Metal Stent; A Matched Analysis From A Real World, Single Center Registry

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